Fear not, for I have redeemed you – Isaiah 43:1

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EMDR

Last year, I attended a trauma training and the trainer touched on eye movement desensitization and reprocessing (EMDR). He stated something like, “It’s very simple, the client moves his eyes back and forth several times and then the feelings associated with the trauma are no longer triggered! For the deeper traumas, they may have to have the process repeated. It’s a very effective and very interesting therapy!” This tends to be how many mental health therapists view EMDR. It is an intriguing enigma because, after years of working to evolve therapy into something that is always helpful, there is finally a method that is shown to be consistently effective.

Francine Shapiro, “discoverer” of EMDR, has stated that EMDR is effective in all traumas, but that “it takes longer when you have multiple traumatic experiences because there are more memories that need to be processed.” Studies upon studies have shown the effectiveness of EMDR because it uses the brain’s natural abilities to heal itself. It is effective, but is it always beneficial?

As I’ve written previously (About PTSD), EMDR pulls the traumas that are stored in the limbic system and brings them into conscious memory, in order to be stored correctly in the cortex. This tends to be a fairly straightforward process for those who have experienced a one-time trauma in adulthood. However, because the childhood brain is so malleable, when children experience a significant trauma, their brains are forced to veer from normal development in order to process the trauma and protect the brain.

One of the very common ways children manage trauma is through dissociation. It is common for these previously dissociated memories to surface in adulthood, mostly because the brain is finally fully developed around age 25 (the topic of recalled memories is quite debated, but it is indeed common). This is a normal process as the brain attempts to bring the memories into consciousness in order to be stored correctly. Some memories become conscious, and some do not; it depends on what the brain feels it can manage at a conscious level. EMDR fast tracks this process and does not allow the brain to pick and choose which memories it is ready for. Therefore, those who have experienced complex trauma (continual trauma during childhood) may become flooded with very intense memories. The complex trauma survivors’ brains have spent years adapting to the trauma and building up walls of protection so the person can survive. EMDR reverses these protections and breaks down the very protective walls they have spent years building.

Many complex trauma survivors who have attempted EMDR have reported that it makes them feel worse and that they are unable to manage the overwhelming feelings. Recalled memories return at such a quick rate that leaves the survivors flooded. The brain is not prepared for an onslaught of memories because naturally, it unfolds trauma at a far slower process. This seems to be what the non-EMDR trained therapist does not understand; I have found myself considering referring clients with complex trauma for EMDR in the past, simply because it is known as an effective therapy for trauma survivors. Now, I realize that in the case of complex trauma, it may be more beneficial to allow the survivors’ brains to unfold the memories at the rate their brains can manage (however slow and exhausting the process may be).

While many mental health therapists are intrigued by EMDR, and rightly so, not every trauma survivor is well-suited for EMDR. Because EMDR fast tracks processing, the processing could take less time, but the process could leave the client in a heap. EMDR therapists understand this and are able to filter their clients accordingly. However, even the smallest safety-building EMDR session may send their complex trauma survivors into a spiral of the past that their minds have worked so hard to forget (I therefore recommend great caution in reading Francine Shapiro’s book, Getting Past Your Past, because it immediately teaches the basic concept of bilateral stimulation to improve safe place).

If you are interested in reading more about a personal account, I invite you to click on the EMDR tag at the bottom of this post.

I spoke with my EMDR therapist last night for the first time in a couple of months. I described the problems I’ve had since the initial session, including significantly increased periods of dissociation and complete loss of memory; two onslaughts of 20-50 long-forgotten memories each; and physical pain. She told me these were major red flags because “We weren’t even digging, we were doing safety stuff. It was supposed to enhance your safety!” She told me she didn’t think EMDR would be a good idea because of the red flags. She explained (as I had found in research recently) that EMDR is most helpful for one-time traumas occurring in adulthood. With complex trauma, the brain has spent years learning to protect itself- EMDR reverses the protections and can easily send a complex trauma survivor into a tailspin. She said case studies she’s read show that complex trauma survivors have needed EMDR for upwards of 3 years before improvement is evident. She said that before EMDR, complex trauma survivors would learn to manage the feelings and memories as it slowly comes back, and would often be in therapy for years and years.

So those are my two options. Be in therapy for years upon years and feel like I do now… Or dive in head-first and break my neck because flooding is a reckless idea in my situation. Receiving real EMDR would cause my brain to break down its protections and I’d basically fall apart. She said that to help me manage my physical pain she could refer me to a chiropractor for massages and pressure point therapy, but that this could trigger stronger body memories than I’m currently having.

It is discouraging to be told I’m too damaged for a type of therapy. It’s also discouraging that I have a long long road to recovery. I am already exhausted. How much more can I endure?

Following my first EMDR session over a week ago, it seems I have regressed to having high anxiety and flashbacks nearly all day. I’ve been needing naps during the day because of my inability to fall back asleep after nighttime feedings. I have not been this exhausted since I was pregnant. I even had a brand new flashback, one that has sent me into hours of researching the cult one side of my family was raised under. However, I know I have not completely regressed because I had a doctor’s appointment two days ago; my fourth in five months for the same problem. I was not triggered during the exam like I typically am. He told me I have “permanent damage” from giving birth and that I’d most likely have mild pain for the rest of my life… unless however, I had more children, then it would worsen. He gave no recommendations, just a professional “suck it up” and was out the door. I was more bothered by the news than the exam itself. It wasn’t until several hours later that I began to spiral because of where his hands were touching me.

I spoke with the EMDR therapist on the phone yesterday and she’s sending me back to my regular therapist for more CBT until both my containment skills are improved and the baby starts sleeping longer. It was so disappointing; I had a glimpse of healing and relief. I am ready to move on with my life.

I have not fully regressed. I still have yet to yell at my son due to his overwhelming urge to exacerbate my symptoms when I only want to be left alone. I even had enough patience to teach him to read three letter words.

Eye movement desensitization and reprocessing (EMDR) research success rates make the treatment appear somewhat magical. If I recall correctly, EMDR is one of the most scientifically based therapies. However, it seems that no matter the level of research I did to prepare myself for the therapy, I had no paradigm for the process until I was the client.

I anxiously sat on the couch and looked around the room as I answered her questions. At the end of the questioning, she told me I was not ready for treatment. She said I need to work on my coping and containment skills; I need to learn to shut my emotions down and not let them spiral; I need to be able to manage my triggers before I reach a 10. She would talk to me in several weeks to determine if I would be ready then.

The therapist noticed my dejected expression and said she’d show me what EMDR was like. I watched her remove the “tappers” from the chest across the room. She handed me a tapper for each hand and calmly stated, “Tell me when you’re in your safe place,” as she returned to her seat. I did, and she told me to describe my safe place, including how I felt and where I felt it, what I heard and what I saw. Then, she turned on the tappers and I felt my hands vibrate alternately for a few seconds each.

After about 15 seconds, she asked me how I felt. I explained that it was difficult to concentrate on my safe place with my hands vibrating. She said we would try one more time. After I had found my safe place, she turned the tappers on once more. “What did you think?” she asked once this set was complete.

“I don’t like these,” I replied.

“Are you okay?”

After what felt like an eternity, I was able to speak. “The tingles from the vibration are the same thing I feel right before I dissociate.” Session was over, but the therapist decided to do the lightsource grounding technique on me. This is where you imagine a light coming in from above and flowing through every inch of your body. Instead of grounding me, I felt myself slipping farther away as it spiraled me into flashbacks.

At some point after I left her office, I dissociated completely. When I was once again cognizant, I nearly panicked because I was driving and had no idea where I was. I was about to pull over when I saw a sign that indicated I was less than five minutes from home. I had never dissociated while driving before, and the flashbacks I had the remainder of the night were stronger than usual.

At a training recently, I heard that trauma is so common that we must assume that everyone we come in contact with has experienced it in some degree- this is part of having a trauma informed perspective. We must have empathy for the negative attitudes or behavior a person may show towards us because we do not know whether these are symptoms of trauma. Normal, processed memories are stored in the cortex of the brain in language form. However, when a person experiences significant trauma, the brain may be altered. This alteration is more serious if the trauma occurs in childhood while the brain is still developing. A significant or unprocessed trauma is stored in the limbic system, or the part of the brain responsible for emotion (including fear). Therefore, each time the person experiences an overwhelming emotion, the brain is triggered and the person reacts with an emotional trauma response.

Because posttraumatic stress disorder (PTSD) involves measurable changes in the brain, PTSD infiltrates every aspect of a person’s life, regardless of how hard that person strives to keep it at bay. Faith, relationships, work, parenthood, marriage, and friendships may suffer, and everyday tasks can become difficult and overwhelming. Many people with PTSD do not sleep well, and may go through periods where they do not sleep at all. There are, of course, varying degrees of this disorder that may depend upon length of time since the trauma, the nature of the trauma itself, support system, environment, ability to cope with symptoms, and whether the trauma has begun to be processed.

There are several different types of trauma therapy, and one of the most common is trauma-focused cognitive behavioral therapy (TF-CBT). This type of therapy works to change a person’s thought process regarding the trauma, and often involves talking about the trauma in depth and coming to an acceptance. CBT in general is heavily present-focused, so a therapist will assist the client in making small, reachable goals regarding moving forward from the trauma. Dialectical behavior therapy (DBT) is also often used. DBT focuses on emotion regulation, especially accepting and controlling overwhelming emotions so that no damage ensues during strong trauma responses. Another common type of therapy is eye movement desensitization and reprocessing (EMDR). This involves the therapist assisting the client in processing the memory through various forms of bilateral stimulation, so the brain can re-store the memory in the cortex. EMDR does not require the client to talk about the trauma in depth, and is short-term because it only focuses on the brain’s ability to heal itself through bilateral stimulation. The best natural example of this is rapid eye movement during sleep, where the brain is able to process what has taken place throughout the day.